Long-term results of laparoscopic sleeve gastrectomy for obesity.

Abstract

OBJECTIVE: To determine the mid- and long-term efficacy and possible side effects of laparoscopic sleeve gastrectomy as treatment for morbid obesity.

SUMMARY BACKGROUND DATA: Laparoscopic sleeve gastrectomy is still controversial as single and final treatment for morbid obesity. Some favorable short-term results have been published, however long-term results are still lacking.

METHODS: In the period between November 2001 and October 2002, 53 consecutive morbidly obese patients who, according to our personal algorithm, were qualified for restrictive surgery were selected for laparoscopic sleeve gastrectomy. Of the 53 patients, 11 received an additional malabsorptive procedure at a later stage because of weight regain. The percentage of excess weight loss (EWL) was assessed at 3 and 6 years postoperatively. A retrospective review of a prospectively collected database was performed for evaluation after 3 years. Recently, after the sixth postoperative year, patients were again contacted and invited to fill out a questionnaire.

RESULTS: Full cooperation was obtained in 41 patients, a response rate of 78%. Although after 3 years a mean EWL of 72.8% was documented, after 6 years EWL had dropped to 57.3%, which according to the Reinhold criteria is still satisfactory. These results included 11 patients who had benefited from an additional malabsorptive procedure (duodenal switch) and 2 patients who underwent a "resleeve" between the third and sixth postoperative year. Analyzing the results of the subgroup of 30 patients receiving only sleeve gastrectomy, we found a 3-year %EWL of 77.5% and 6+ year %EWL of 53.3%. The differences between the third and sixth postoperative year were statistically significant in both groups. Concerning long-term quality of life patient acceptance stayed good after 6 + years despite the fact that late, new gastro-esophageal reflux complaints appeared in 21% of patients.

CONCLUSIONS: In this long-term report of laparoscopic sleeve gastrectomy, it appears that after 6+ years the mean excess weight loss exceeds 50%. However, weight regain and de novo gastroesophageal reflux symptoms appear between the third and the sixth postoperative year. This unfavorable evolution might have been prevented in some patients by continued follow-up office visits beyond the third year. Patient acceptance remains good after 6+ years.

This is very interesting. I too wonder what happens in years three to six. Last support group we asked dr. C if regain occurs, when does that usuall happen. he said for vsg and rny it was years 2 or 3. For DS, it was more like year 6. and for band it could be anytime. So when he and jossart's 5 year study gets published in a few months, it will be interesting to compare. The post was only the abstract and I am wondering if the paper discussed what size bougie was used on these patients. I know cirangle and jossart concluded that the smaller bougie had better long term results. guess there are lots of factors we may never know about. Anyone know where to read the full study? diane

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Doesn't hold much water if you ask me! #1 how big were they made (2 had to be "re-sleeved" ) implying stretching of the sleeve, (Dr. C already said significant weight regain was present at about year 4, when he was using bigger bougie sizes! #2 30 patients....really? not a very big/complete study! #3 how were the patients screened/selected....were they given psych evals, were they given info/support to help them be more successful, or were they on their own after! (sleeve em and leave em!) This was common 10 years ago! # 4 what were the BMI etc of the patients?
It said the "unfavorable evolution" might have been avoided if they were give long term care/ follow up! This 1 report is not what I would base my possible future results on! But take note......long term care follow up and support are important for success.........but you all already knew that! Mini.....please note if I sound a bit defensive or miffed, it is not directed at you! just a bit of the collateral damage from all the BS surgery wars around here lately!

well i guess i looked at it a bit different, i looked at it that being 2001 -2002 it was probably bigger bougies, and even though there does seem to be a problem between year 3 and yr 6 they still at 6 years out managed to keep over 50 % of their weight loss off... which must be something that the people that have bigger sleeves can find some comfort in.. they still at 6 yrs out had not regained all their weight.

something must have happened for it to show statistically that most had a problem between year 3-6 and they are suggesting that its because they lost follow up care.. which still pushes home the fact we need to keep our head in the game.

and dont worry i dont mind you being defensive, i just think even the reports that do not look so stella are important info to have, because maybe there is something we can learn from them, even if it is to not give up on oh and or support groups.

Linda 5".46lbs under goal weight Join US On The VSG Maintenance Group Forum!!
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Well I must admit I don't see this as a favorable report at all. However, I'm going to look at it the same as Jimbo and just assume that the sleeves were made much bigger and that would account for the regain. But I don't think most of us with the normal 32 - 40 bougies would fall into that category...although I'm very happy to have gotten a 32f myself, despite my trouble with acid reflux.

Did they change their relationship with food? Were there ever the necessary changes in their eating habits? I personally know RNYers who continued with their horrible eating habits...mushies were blended snickers and sees candies. I am not sure if the staples were ripped I do know that they blamed it on the RNY and not their eating habits or their relationship with food, the reasons why they were eating.

Frankly, I take most of this with a grain of salt. I think the weight regain issue is very complicated and is more related to our relationship with food and maintaining the lifestyles changes that successful weight loss surgery mandates. One can have the best surgical technique in the world, but it doesn't change the WLS person's brain. The surgery may get us to goal or a healthier BMI, but it is up to us to keep us at a healthy weight. This requires the development of healthy habits from the beginning. The further out that people get, it may be more difficult to be as mindful as we are, in the beginning stages, when everything is exciting and new. As the saying goes, "They operate on our stomachs, but not our brains." The further out that we all get, it becomes more and more about personal responsibility and maintenance of a healthier lifestyle.

I am going to try to get the full text of this paper. May have to go to local library to see if they have subscription to Pub Med if i can't get it on line. It might tell more stuff like bougie size etc.

And while I don't like some of what I read, I choose to look on the positive side and plan to put myself in the category of one of the ones who maintains the loss over 6 years. I already lost 100% of excess weight; not 50%. I got rid of acid reflux with hernia repair. If I get reflux again i can take meds for it. The main thing is commitment to long term management of this issue. My surgeon provides 5 year follow up. And I am sure that if I want more I can purchase it and its worth is. And I will probably be hanging around here at OH in 5 years blathering about the same stuff. And if I need to start my own support group locally I will do so. So during years three to six I guess I know to be especially vigilent and gotta get the exercise element well in place by then - my main failure.

So lets see what we can learn from this to advance our own success. Diane

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